[Intra-aortic balloon counterpulsation placed through the subclavian artery as a bridge to heart transplantation. Case report]. / Balón de contrapulsación intraaórtico por acceso subclavio como puente a trasplante cardíaco. Reporte de casos.

Advanced heart failure is a major health problem for which heart transplantation or left ventricular assist devices are the only effective treatments. Intra-aortic balloon pump inserted using femoral artery access as a bridge to heart transplantation is still frequently used, but has the disadvantage of limiting the patient's movements, hence exposing him or her to the hazards of immobility and threatening the success of the procedure or hindering recovery. Access through the subclavian artery has become an attractive alternative since it doesn't impair the patient's mobility, and there is increasing evidence supporting its use. We present the first case of subclavian counterpulsation balloon implantation in a cardiovascular care center in Colombia.

Mid-Term Outcome after Tricuspid Valve Replacement.

OBJECTIVE: To evaluate the mid-term survival rate after tricuspid valve replacement (TVR). METHODS: We retrospectively studied 110 consecutive patients who underwent TVR from January 2007 to November 2017. A survival analysis was performed with the Kaplan-Meier method and the log-rank test. RESULTS: The median survival was 65.81 months. Mean age was 50 (range 39 to 59) years. Forty-eight patients (43.6%) were male, and 62 patients (56.4%) were female. Most of the patients (78.5%) were categorized into the New York Heart Association (NYHA) functional classes III/IV. Seventy-two patients (65.5%) had isolated TVR. Six-three patients (57.3%) had previously undergone heart surgery. The Kaplan-Meier survival rates at one year, three years, and five years were 59.0%±5%, 52.0%±6%, and 48.0%±6%, respectively. A Cox regression analysis demonstrated that the risk factors for mid-term mortality were advanced NYHA class (hazard ratio [HR] 2.430, 95% confidence interval [CI] 1.099-5.375, P=0.028), need for continuous renal replacement therapy (CRRT) treatment (HR 3.121, 95% CI 1.610-6.050, P=0.001), and need for intra-aortic balloon pump (IABP) treatment (HR 3.356, 95% CI 1.072-10.504, P=0.038). CONCLUSION: In TVR, impaired cardiac function before the operation and a need for CRRT or IABP treatment after the operation is independently associated with increased mid-term mortality.

Mid-term outcome after tricuspid valve replacement

Abstract Objective: To evaluate the mid-term survival rate after tricuspid valve replacement (TVR). Methods: We retrospectively studied 110 consecutive patients who underwent TVR from January 2007 to November 2017. A survival analysis was performed with the Kaplan-Meier method and the log-rank test. Results: The median survival was 65.81 months. Mean age was 50 (range 39 to 59) years. Forty-eight patients (43.6%) were male, and 62 patients (56.4%) were female. Most of the patients (78.5%) were categorized into the New York Heart Association (NYHA) functional classes III/IV. Seventy-two patients (65.5%) had isolated TVR. Six-three patients (57.3%) had previously undergone heart surgery. The Kaplan-Meier survival rates at one year, three years, and five years were 59.0%±5%, 52.0%±6%, and 48.0%±6%, respectively. A Cox regression analysis demonstrated that the risk factors for mid-term mortality were advanced NYHA class (hazard ratio [HR] 2.430, 95% confidence interval [CI] 1.099-5.375, P=0.028), need for continuous renal replacement therapy (CRRT) treatment (HR 3.121, 95% CI 1.610-6.050, P=0.001), and need for intra-aortic balloon pump (IABP) treatment (HR 3.356, 95% CI 1.072-10.504, P=0.038). Conclusion: In TVR, impaired cardiac function before the operation and a need for CRRT or IABP treatment after the operation is independently associated with increased mid-term mortality.

Fulminant myocarditis due to the influenza B virus in adults: Report of two cases and literature review / Miocarditis fulminante en adultos por el virus de la influenza B: reporte de dos casos y revisión de la literatura

La miocarditis es una enfermedad inflamatoria del miocardio. Las infecciones virales son la causa más común, aunque también puede deberse a reacciones de hipersensibilidad y de etiología autoinmunitaria, entre otras. El espectro clínico de la enfermedad es variado y comprende desde un curso asintomático, seguido de dolor torácico, arritmias y falla cardiaca aguda, hasta un cuadro fulminante. El término 'fulminante' se refiere al desarrollo de un shock cardiogénico con necesidad de soporte vasopresor e inotrópico o dispositivos de asistencia circulatoria, ya sea oxigenación por membrana extracorpórea o balón de contrapulsación intraaórtico. Cerca del 10 % de los casos de falla cardiaca por miocarditis corresponde a miocarditis fulminante. La miocarditis por influenza se considera una condición infrecuente; no obstante, su incidencia ha aumentado desde el 2009 a raíz de la pandemia de influenza por el virus AH1N1. Por su parte, la miocarditis por influenza de tipo B sigue siendo una condición infrecuente. Se describen aquí dos casos confirmados de miocarditis fulminante por el virus de la influenza B atendidos en un centro cardiovascular, que requirieron dispositivos de asistencia circulatoria mecánica.

Myocarditis is an inflammatory disease of the myocardium. Viral infections are the most common cause, although it can also be due to hypersensitivity reactions and autoimmune etiology, among other causes. The clinical spectrum of the disease is varied, from an asymptomatic course, followed by chest pain, arrhythmias, and acute heart failure, to a fulminant episode. The term fulminant refers to the development of cardiogenic shock with a need for vasopressor support and inotropic or assisted circulation devices either extracorporeal membrane oxygenation (ECMO) or intra-aortic counterpulsation balloon. About 10% of cases of heart failure due to myocarditis correspond to fulminant myocarditis. Influenza myocarditis has been considered an infrequent condition. However, its incidence has increased since 2009 as a result of the AH1N1 pandemic; otherwise, myocarditis due to the Influenza type B virus remains an infrequent entity. We describe the experience in a cardiovascular center of two confirmed cases of fulminant myocarditis due to influenza B that required circulatory assistance devices.

Miocarditis fulminante en adultos por el virus de la influenza B: reporte de dos casos y revisión de la literatura / Fulminant myocarditis due to the influenza B virus in adults: Report of two cases and literature review

Resumen La miocarditis es una enfermedad inflamatoria del miocardio. Las infecciones virales son la causa más común, aunque también puede deberse a reacciones de hipersensibilidad y de etiología autoinmunitaria, entre otras. El espectro clínico de la enfermedad es variado y comprende desde un curso asintomático, seguido de dolor torácico, arritmias y falla cardiaca aguda, hasta un cuadro fulminante. El término 'fulminante' se refiere al desarrollo de un shock cardiogénico con necesidad de soporte vasopresor e inotrópico o dispositivos de asistencia circulatoria, ya sea oxigenación por membrana extracorpórea o balón de contrapulsación intraaórtico. Cerca del 10 % de los casos de falla cardiaca por miocarditis corresponde a miocarditis fulminante. La miocarditis por influenza se considera una condición infrecuente; no obstante, su incidencia ha aumentado desde el 2009 a raíz de la pandemia de influenza por el virus AH1N1. Por su parte, la miocarditis por influenza de tipo B sigue siendo una condición infrecuente. Se describen aquí dos casos confirmados de miocarditis fulminante por el virus de la influenza B atendidos en un centro cardiovascular, que requirieron dispositivos de asistencia circulatoria mecánica.

Abstract Myocarditis is an inflammatory disease of the myocardium. Viral infections are the most common cause, although it can also be due to hypersensitivity reactions and autoimmune etiology, among other causes. The clinical spectrum of the disease is varied, from an asymptomatic course, followed by chest pain, arrhythmias, and acute heart failure, to a fulminant episode. The term fulminant refers to the development of cardiogenic shock with a need for vasopressor support and inotropic or assisted circulation devices either extracorporeal membrane oxygenation (ECMO) or intra-aortic counterpulsation balloon. About 10% of cases of heart failure due to myocarditis correspond to fulminant myocarditis. Influenza myocarditis has been considered an infrequent condition. However, its incidence has increased since 2009 as a result of the AH1N1 pandemic; otherwise, myocarditis due to the Influenza type B virus remains an infrequent entity. We describe the experience in a cardiovascular center of two confirmed cases of fulminant myocarditis due to influenza B that required circulatory assistance devices.

Intra-aortic balloon pump in cardiogenic shock: state of the art / Balão intra-aórtico no choque cardiogênico: o estado da arte

ABSTRACT The clinical definition of cardiogenic shock is that of a low cardiac output and evidence of tissue hypoxia in the presence of adequate blood volume. Cardiogenic shock is the main cause of death related to acute myocardial infarction (AMI), with a mortality rate of 45-70% in the absence of aggressive and highly specialized technical care. The intra-aortic balloon pump (IABP) is one of the most widely used mechanical assisting devices. During the last two decades, about 42% of patients with AMI who evolved with cardiogenic shock received mechanical circulatory assistance with IABP. Its clinical indication has been based on non-randomized studies and registry data. Recent studies have shown that the use of IABP did not reduce 30-day mortality in patients with AMI and cardiogenic shock treated with the strategy of early myocardial revascularization as the planned primary objective. The guidelines of the American Heart Association and of the European Society of Cardiology have reassessed their recommendations based on the results of meta-analyzes, including the IABP-SCHOCK II Trial study, which did not evidence an increase in survival of patients who received mechanical support with IABP. This review article addresses the clinical impact of IABP use in the cardiogenic shock caused by AMI.

RESUMO A definição clínica de choque cardiogênico é a de um quadro de baixo débito cardíaco e evidência de hipóxia tecidual, na presença de volemia adequada. O choque cardiogênico representa a principal causa de óbito relacionada ao infarto agudo do miocárdio (IAM), com índice de mortalidade em torno de 45% a 70%, na ausência de cuidados técnicos agressivos e altamente especializados. O balão intra-aórtico (BIA) é um dos dispositivos de assistência mecânica mais utilizados no mundo. Nas duas últimas décadas, cerca de 42% dos pacientes com IAM, que evoluíram com choque cardiogênico, receberam assistência circulatória mecânica com BIA. Sua indicação clínica tem sido baseada em estudos não randomizados e dados de registro. Estudos recentes têm demonstrado que o uso do BIA não reduziu a mortalidade hospitalar (30 dias) em pacientes com IAM e choque cardiogênico, tratados com a estratégia de revascularização precoce do miocárdio como objetivo primário planejado. As diretrizes da Associação Americana de Cardiologia e da Sociedade Europeia de Cardiologia reavaliaram suas recomendações, baseadas nos resultados de metanálises, incluindo o estudo IABP-SCHOCK II Trial, que não evidenciou aumento na sobrevida de pacientes que receberam suporte mecânico com BIA. Este artigo de revisão aborda o impacto clínico do uso do BIA no choque cardiogênico ocasionado pelo IAM.

Uso do balão intra-aórtico no trans e pós-operatório de cirurgia cardíaca: análise de 80 casos consecutivos / Use of intra-aortic balloon pump in cardiac surgery: analysis of 80 consecutive cases

FUNDAMENTO: A síndrome de baixo débito cardíaco no perioperatório de cirurgia cardíaca pode incidir em cerca de 10 a 15% dos pacientes; desse total, 2% necessitam de suporte mecânico para adequado controle hemodinâmico. OBJETIVOS: Descrever a mortalidade de pacientes que necessitaram utilizar balão intra-aórtico (BIAo) no trans ou pós-operatório de cirurgia cardíaca, identificando variáveis pré-operatórias associadas a pior desfecho, assim como descrever as complicações pós-operatórias e a sobrevida em médio prazo. MÉTODOS: Estudo de coorte retrospectivo incluindo 80 casos consecutivos entre janeiro/2009 e setembro/2011. Os pacientes possuíam, em média, 62,9 ± 11,3 anos e 58,8% eram do sexo masculino. Na amostra, 81,3% dos pacientes eram hipertensos, 50% tinham infarto do miocárdio prévio e 38,8%, insuficiência cardíaca NYHA III/IV. A principal cirurgia realizada foi a revascularização miocárdica isolada (37,5%). RESULTADOS:A mortalidade hospitalar nesta série foi de 53,8% (IC95%: 42,7-64,9), sendo o tempo de isquemia > 90 minutos preditor independente de mortalidade em análise multivariada (RR 1,52 IC95%: 1,04-2,22). Em relação às complicações, 71,3% (IC95%: 61,2-81,4) dos pacientes apresentaram ao menos uma complicação adicional no período perioperatório, sendo a isquemia do membro inferior observada em 5% dos pacientes. A sobrevida em 1 ano foi de 43,6%, observando-se um platô na curva de sobrevida após uma queda acentuada inicial, relacionada à mortalidade hospitalar. CONCLUSÕES: Os pacientes que necessitam do BIAo compõem um grupo de muito alto risco para morbidade e mortalidade; seu emprego, entretanto, permite recuperar muitos pacientes de uma evolução que seria invariavelmente fatal, tendo os pacientes com alta hospitalar uma boa sobrevida em médio prazo.

BACKGROUND: About 10% to 15% of patients undergoing cardiac surgery may develop low cardiac output syndrome in the perioperative period; of this total, 2% require mechanical support for adequate hemodynamic control. OBJECTIVE: To describe the mortality rates of patients who required the use of IABP in the perioperative or postoperative period of cardiac surgery, identifying preoperative variables associated with a worse outcome, as well as to describe the postoperative complications and medium-term survival. METHODS: Retrospective cohort study including 80 consecutive cases between January/2009 and September/ 2011. The patients had on average 62.9 ± 11.3 years and 58.8% were male; 81.3% were hypertensive, 50.0% had prior myocardial infarction and 38.8% has NYHA III/IV heart failure. The mainsurgery performed was isolated coronary artery bypass grafting (37.5%). RESULTS: Hospital mortality was 53.8% (IC 95%: 42.7-64.9), and cross-clamp time > 90 minutes was an independent predictor of mortality in multivariate analysis (OR 1.52 CI 95%: 1.04-2.22). 71.3% of patients (CI 95%: 61.2-81.4) had at least one additional complication in the perioperative period, with lower limb ischemia observed in 5.0% patients. One-year survival was 43.6%, with a plateau in survival rates after a sharp initial drop, related to hospital mortality. CONCLUSION: Patients who require IABP comprise a group of very high risk for morbidity and mortality. IABP use, however, enables the recovery of many patients from an evolution that would invariably be fatal, and patients discharged from hospital have a good medium-term survival.

Validation of a protocol to assist patients with intra-aortic balloon

OBJECTIVE: To develop a protocol of care for patients with Intra-Aortic Balloon and validate the content of this protocol. METHODS: Study of quantitative and descriptive approach. The methodology followed three steps: development of the instrument; content validity and reliability verification of the protocol for the analysis of agreement between specialists with greater experience. The study included 48 specialists, including physicians and nurses experienced in patient care in use of balloon. Items considered valid achieved at least 75% of consensus before the analysis of agreement between evaluators. RESULTS: We evaluated 36 items, of these, 20 were considered valid. The reliability was also verified, using consistency of the responses of more experienced evaluators. Among the items submitted to new statistical analysis by these evaluators, only two were considered valid. CONCLUSION: Based on the content validation, a protocol with 22 items concerning patient care without the use of intra-aortic balloon was developed.

OBJETIVOS: Elaborar um protocolo de cuidados a pacientes com Balão Intra Aórtico e validar o conteúdo desse protocolo. MÉTODOS: Estudo de abordagem quantitativa, descritivo. A trajetória metodológica seguiu três etapas: elaboração do instrumento; validação do conteúdo e verificação da confiabilidade do protocolo pela análise de concordância entre peritos com maior tempo de experiência. Participaram do estudo 48 peritos, entre médicos e enfermeiros, experientes em assistência ao paciente em uso do balão. Os itens considerados válidos obtiveram consenso mínimo de 75% perante a análise de concordância entre os avaliadores. RESULTADOS: Foram avaliados 36 itens, destes, 20 foram considerados válidos. Verificou-se também a confiabilidade, utilizando a congruência das respostas dos avaliadores mais experientes. Dos itens submetidos à nova análise estatística por esses avaliadores, apenas dois foram considerados válidos. CONCLUSÃO: Com base na validação do conteúdo, elaborou-se um protocolo com 22 itens referentes aos cuidados a paciente sem uso do Balão Intra-Aórtico.

OBJETIVOS: Elaborar un protocolo de cuidados a pacientes con Balón Intraaórtico y validar el contenido de ese protocolo. MÉTODOS: Estudio de abordaje cuantitativo, descriptivo. La trayectoria metodológica siguió tres etapas: elaboración del instrumento; validación del contenido y verificación de la confiabilidad del protocolo por el análisis de concordancia entre peritos con mayor tiempo de experiencia. Participaron en el estudio 48 peritos, entre médicos y enfermeros, con experiencia en asistencia al paciente en uso del balón. Los items considerados válidos obtuvieron consenso mínimo del 75% frente al análisis de concordancia entre los evaluadores. RESULTADOS: Fueron evaluados 36 items, de éstos, 20 fueron considerados válidos. Se verificó también la confiabilidad, utilizando la congruencia de las respuestas de los evaluadores más experientes. De los items sometidos al nuevo análisis estadístico por esos evaluadores, apenas dos se considerarons válidos. CONCLUSIÓN: Con base en la validación del contenido, se elaboró un protocolo con 22 items referentes a los cuidados al paciente sin uso del Balón Intraaórtico.

Takotsubo Cardiomyopathy: A Cardiac Syndrome Mimicking Acute Myocardial Infarction in a Liver Transplant Recipient.

Takotsubo cardiomyopathy (TTC) is a rare clinical syndrome defined as a profound but reversible left ventricular dysfunction in the absence of coronary artery disease. We describe the clinical features and management of TC manifesting in the postoperative period in a patient undergoing liver transplantation. Two days after surgery, the patient developed clinical features of acute myocardial infarction. Ecochardiography revealed hypokinesis of the left ventricle. Coronary angiography revealed normal arteries without any stenosis or obstruction. The patient required vasopressor and inotropic support. The placement of intra-aortic balloon pump had a beneficial effect on the management of heart failure. The patient had a complete recovery of cardiac function 40 days after surgery. TC is a possible occurrence after liver transplant. Awareness of this condition is essential as early diagnosis and prompt management can save the patient's life.

Complications of intra-aortic balloon in a cohort of hospitalized patients: implications for nursing care / Complicaciones del balón intraaórtico en una cohorte de pacientes hospitalizados: implicaciones para la asistencia de enfermería / Complicações do balão intra-aórtico em uma coorte de pacientes hospitalizados: implicações para a assistência de enfermagem

OBJECTIVES: To describe complications associated to the use of intra-aortic balloon pumps (IABP), and their relationship with dwelling time, presence of risk factors/comorbidities, and nursing records. METHODS: Retrospective cohort study, in which medical records were analyzed through the completion of specifically designed forms. RESULTS: In total, 104 patients were included, with mean age 65±11 years, 52 percent men; 26 (25 percent) of them presented vascular complications, more frequently ischemia (25 percent); peripheral vascular disease was the risk factor/comorbidity more frequently related to complications (56.3 percent; p=0.003). Nursing records showed that the use of catheter was recorded in 30 cases (29 percent), and the patient's clinical situation after its removal in 28 cases (27 percent). CONCLUSION: This study showed that the frequency of complications related to IABP is high. Considering risk factor/comorbidity factors, peripheral vascular disease was significantly associated to complications. Nursing records were sub-optimal.

Este estudio tuvo como objetivos describir las complicaciones provenientes de la utilización del balón intraaórtico (BIA), relacionándolas con el tiempo de permanencia, con la presencia de factores de riesgo/enfermedades concomitantes y con los registros de enfermería. Se utilizó como método la cohorte histórica, con análisis de fichas por medio del llenado de un instrumento construido específicamente para el estudio. Después de la evaluación de 104 pacientes, edad promedio 65±11, 52 por ciento sexo masculino, los resultados mostraron que 26 (25 por ciento) presentaron complicaciones vasculares, siendo la isquemia (25 por ciento) la más incidente; entre los factores de riesgo/enfermedades concomitantes, el que más se relacionó con complicaciones fue la enfermedad vascular periférica (56,3 por ciento, p=0,003). En lo que se refiere a las evaluaciones de enfermería, 30 (29 por ciento) presentaban registro del uso del catéter, y 28 (27 por ciento) relataban el estado clínico del paciente después de su retirada. Se concluye que este estudio demostró que el índice de complicaciones es todavía alto cuando relacionado al BIA. Entre los factores de riesgo/enfermedades concomitantes, la enfermedad vascular periférica fue significativamente relacionada con complicaciones. Los registros de los enfermeros no fueron exhautivos.

Este estudo teve como objetivos descrever as complicações decorrentes da utilização do balão intra-aórtico (BIA), relacionando-as com o tempo de permanência, com a presença de fatores de risco/comorbidades e com os registros de enfermagem. Utilizou-se como método a coorte histórica, com análise de prontuários por meio de preenchimento de instrumento específico para o estudo. Após avaliação de 104 pacientes, idade média 65±11, 52 por cento sexo masculino, os resultados mostraram que 26 (25 por cento) apresentaram complicações vasculares, sendo a isquemia (25 por cento) a mais incidente; entre os fatores de risco/comorbidades, o que mais se relacionou com complicações foi a doença vascular periférica (56,3 por cento, p=0,003). Quanto às evoluções de enfermagem, 30 (29 por cento) apresentavam registro do uso do cateter, e 28 (27 por cento) relatavam o estado clínico do paciente após a sua retirada. Conclui-se que este estudo demonstrou que o índice de complicações ainda é alto quando relacionado ao BIA. Dentre os fatores de risco/comorbidades, a doença vascular periférica foi significativamente relacionada com complicações. Os registros dos enfermeiros foram subótimos.